Outcome Analysis and Cost Comparison Between Externalized Pyeloureteral and Standard Stents in 470 Consecutive Open Pyeloplasties
2008; Lippincott Williams & Wilkins; Volume: 180; Issue: 4S Linguagem: Inglês
10.1016/j.juro.2008.05.084
ISSN1527-3792
AutoresLuis H. Braga, Armando J. Lorenzo, Walid A. Farhat, Darius Bägli, Antoine E. Khoury, João L. Pippi Salle,
Tópico(s)Ureteral procedures and complications
ResumoNo AccessJournal of UrologyKidney/Hydronephrosis1 Oct 2008Outcome Analysis and Cost Comparison Between Externalized Pyeloureteral and Standard Stents in 470 Consecutive Open Pyeloplasties Luis H.P. Braga, Armando J. Lorenzo, Walid A. Farhat, Darius J. Bägli, Antoine E. Khoury, and Joao L. Pippi Salle Luis H.P. BragaLuis H.P. Braga , Armando J. LorenzoArmando J. Lorenzo , Walid A. FarhatWalid A. Farhat , Darius J. BägliDarius J. Bägli , Antoine E. KhouryAntoine E. Khoury , and Joao L. Pippi SalleJoao L. Pippi Salle View All Author Informationhttps://doi.org/10.1016/j.juro.2008.05.084AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Despite the widespread use of ureteral stents for pyeloplasty by pediatric urologists there is ongoing controversy regarding the most advantageous type of transanastomotic drainage. We compared patients who underwent placement of an externalized pyeloureteral Salle intraoperative pyeloplasty stent (Cook Urological, Spencer, Indiana) to those who had a standard Double-J® ureteral stent placed to assess the benefits, drawbacks and costs of each modality during open pyeloplasty. Materials and Methods: Our study sample comprised 470 age matched children who underwent primary open pyeloplasty in an 11-year period. A total of 242 patients (51.5%) underwent Double-J ureteral stent insertion and 228 (48.5%) underwent placement of a Salle intraoperative pyeloplasty stent at surgery. Operative time, hospital stay, overall complication and success rates, type of complications and hospital costs were compared between the 2 groups. Results: Median age was 18 months and median followup was 39 months. Mean hospital stay was 3.0 and 3.1 days in children with a Double-J ureteral and a Salle intraoperative pyeloplasty stent, respectively (p = 0.7). The overall complication rate was 9.9% (24 of 242 patients) for the Double-J ureteral stent vs 8.3% (19 of 228) for the Salle intraoperative pyeloplasty stent (p = 0.6). Complications in patients with a Double-J ureteral stent consisted of urinoma in 3, return visits due to bladder spasms in 7 or catheter obstruction in 6 and readmission due to pyelonephritis in 5. Complications in children with a Salle intraoperative pyeloplasty stent involved urinoma in 1, prolonged drainage through the Penrose drain in 5 and readmission due to pyelonephritis in 1. Recurrent ureteropelvic junction obstruction developed in 12 cases per group. The success rate was 95.0% (230 of 242 cases) and 94.7% (216 of 228) for the Double-J ureteral and the Salle intraoperative pyeloplasty stent, respectively (p = 0.2). Hospital charges, including the surgical procedure, postoperative hospitalization and cystoscopy or a clinical visit for catheter removal, in patients with a Double-J ureteral and a Salle intraoperative pyeloplasty stent were $9,825 and $9,260, respectively. Conclusions: The 2 ureteral stents are equivalent in regard to overall complication and success rates after pyeloplasty. However, Salle intraoperative pyeloplasty stent insertion was associated with a Canadian $565 cost decrease per patient and most importantly the preclusion of a second general anesthesia for catheter removal. References 1 : Nephrostomy tube drainage with pyeloplasty: is it necessarily a bad choice?. J Urol2000; 163: 1528. Link, Google Scholar 2 : Stented versus nonstented pediatric pyeloplasty: a modern series and review of the literature. J Urol2002; 168: 1127. Link, Google Scholar 3 : Complications and length of hospital stay following stented and unstented paediatric pyeloplasties. Br J Urol1994; 73: 87. 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Google Scholar Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario Canada© 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited ByYiee J and Baskin L (2018) Use of Internal Stent, External Transanastomotic Stent or No Stent During Pediatric Pyeloplasty: A Decision Tree Cost-Effectiveness AnalysisJournal of Urology, VOL. 185, NO. 2, (673-681), Online publication date: 1-Feb-2011.Helmy T, Blanc T, Paye-Jaouen A and El-Ghoneimi A (2018) Preliminary Experience With External Ureteropelvic Stent: Alternative to Double-J Stent in Laparoscopic Pyeloplasty in ChildrenJournal of Urology, VOL. 185, NO. 3, (1065-1070), Online publication date: 1-Mar-2011.Ruiz E, Soria R, Ormaechea E, Lino M, Moldes J and de Badiola F (2011) Simplified Open Approach to Surgical Treatment of Ureteropelvic Junction Obstruction in Young Children and InfantsJournal of Urology, VOL. 185, NO. 6S, (2512-2516), Online publication date: 1-Jun-2011.Bayne A, Lee K, Nelson E, Cisek L, Gonzales E and Roth D (2011) The Impact of Surgical Approach and Urinary Diversion on Patient Outcomes in Pediatric PyeloplastyJournal of Urology, VOL. 186, NO. 4S, (1693-1699), Online publication date: 1-Oct-2011. Volume 180Issue 4SOctober 2008Page: 1693-1699 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordssurgicalkidneycomplicationsanastomosisureterstentsAcknowledgmentsPatrick Harty assisted with SIPS design and commercialization.MetricsAuthor Information Luis H.P. Braga More articles by this author Armando J. Lorenzo More articles by this author Walid A. Farhat More articles by this author Darius J. Bägli More articles by this author Antoine E. Khoury More articles by this author Joao L. Pippi Salle Financial interest and/or other relationship with Cook Urological. More articles by this author Expand All Advertisement PDF DownloadLoading ...
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